Compositions and methods for intervertebral disc reformation

ABSTRACT

Methods of reforming degenerated intervertebral discs. Hybrid materials useful in methods of reforming degenerated intervertebral discs.

This Application is a divisional of U.S. provisional Application Ser.No. 08/694,191 filed Aug. 8. 1996 now U.S. Pat. No. 5,964,807, issuedOct. 12, 1999.

FIELD OF THE INVENTION

The present invention concerns methods and materials useful forreforming degenerated discs of the spine of a vertebrate and inparticular the spine of a human.

BACKGROUND OF THE INVENTION

Back pain is one of the most frequently reported musculoskeletalproblems in the United States. 80% of the adults will miss work at leastthree times in their career due to back pain. The most common factorcausing low back pain is the degeneration of the disc. At the agesbetween 35 to 37, approximately a third of the U.S. population havesuffered from a herniated disc.

The main functions of the spine are to allow motion, transmit load andprotect the neural elements. The vertebrae of the spine articulate witheach other to allow motion in the frontal, sagittal and transverseplanes. As the weight of the upper body increases, the vertebral bodieswhich are designed to sustain mainly compressive loads, increase in sizecaudally. The intervertebral disc is a major link between the adjacentvertebrae of the spine. The intervertebral disc, the surroundingligaments and muscles provide stability to the spine.

The intervertebral discs make up about 20-33% of the lumbar spinelength. They are capable of sustaining weight and transferring the loadfrom one vertebral body to the next, as well as maintaining a deformablespace to accommodate normal spine movement. Each disc consists of agelatinous nucleus pulposus surrounded by a laminated, fibrous annulusfibrosus, situated between the end plates of the vertebrae above andbelow.

The nucleus pulposus contains collagen fibrils and water-bindingglycosaminoglycans. At birth, the nucleus pulposus contains 88% water,however, this percentage decreases with age. This water loss decreasesits ability to withstand stress. The annulus fibrosus consists offibrocartilaginous tissue and fibrous protein. The collagen fibers arearranged in between 10 to 20 lamellae which form concentric rings aroundthe nucleus pulposus. The collagen fibers within each lamella areparallel to each other and runs at an angle of approximately 60 degreesfrom vertical. The direction of the inclination alternates with eachlamellae. This crisscross arrangement enables the annulus fibrosus towithstand torsional and bending loads. The end-plates are composed ofhyaline cartilage, and are directly connected to the lamellae which formthe inner one-third of the annulus.

When under compressive loads, the nucleus pulposus flattens and bulgesout radially. The annulus fibrosus stretches, resisting the stress. Theend-plates of the vertebral body also resist the ability of the nucleuspulposus to deform. Thus, pressure is applied against the annulus andend-plate, transmitting the compressive loads to the vertebral body.When tensile forces are applied, the disc is raised to a certain heightstraining the collagen fibers in the annulus. At bending, one side ofthe disc is in tension while the other side is in compression. Theannulus of the compressed side bulges out.

When the disc is subjected to torsion, there are shear stresses whichvary proportionally to the distance from the axis of rotation, in thehorizontal and axial plane. The layer of fibers oriented in the angle ofmotion is in tension while the fibers in the preceding or succeedinglayer are relaxed. Similarly in sliding, the fibers oriented in thesliding direction are in tension while the fibers in the other layersrelax.

Repeated rotational loading initiates circumferential tears in theannulus fibrosus, which gradually form radial tears into the nucleuspulposus until the nucleus degrades within the disc. In addition to thewater loss which occurs with age, more water is also lost due to nucleusrupture, thereby reducing its ability to resist compressive loads. Assuch, the annulus bulges. As the severity of the tear increases, much ofthe contents of the disc is lost leaving a thin space of fibrous tissue.This condition is called disc resorption.

Increasing disc collapse can cause facet subluxation and stenosis of theintervertebral foramen. Subsequently, the degenerative process involvesthe facet joints equally. As the annulus bulges out posteriorly into thespinal canal, the nerve root may be compressed causing sciatica. Pain isfelt from the lower back to the buttocks and the leg. Following therupture of the disc, excessive motions such as excessive extension orflexion can occur, resulting in spine segmental instability. The spineis thus more vulnerable to trauma. Herniation can occur due to discdegeneration or excessive load factors especially compression. Pain mayresult due to nerve root compression caused by protrusions.

The unstable phase of the degeneration progress allowing excessivemovement may result in degenerative spondylolisthesis, which is abreakdown of posterior joints. The nerve is trapped between the inferiorarticular facet of the vertebrae above and the body of that below. Thus,sliding of a vertebral body on another damages the posterior joints dueto fatigue and apply traction on the nerve root causing pain.

Surgical treatments for herniated disc include laminectomy, spinalfusion and disc replacement with protheses.

At this time, 150,000 spinal fusion procedures are performed per year inthe US alone, and the numbers are growing exponentially. However, theresults of spinal fusions are very varied. Some of the effects includenon-unions, slow rate of fusion even with autografts, and significantfrequency of morbidity at the graft donor site. In addition, even if thefusion is successful, joint motion is totally eliminated. Adverseeffects of spinal fusions have also been reported on adjacent unfusedsegments such as disc degeneration, herniation, instabilityspondylolysis and facet joint arthritis. A long-term follow-up of lowerlumbar fusions in patients from 21 to 52 years of age found that 44% ofpatients with spinal fusions were currently still experiencing low-backpain and 57% had back pain within the previous year. 53% of the patientstracked were on medication, 5% had late sequela secondary surgery, 15%had a repeat lumbar surgery, 42% had symptoms of spinal stenosis, and45% had instability proximal to their fusion. This clinical data showsthat significant long-term limitations are associated with spinalfusion.

An alternative to spinal fusion is the use of an intervertebral discprosthesis. Ideally, a successful disc prosthesis will simulate thefunction of a normal disc. The disc replacement must be capable ofsustaining weight and transferring load from one vertebral body to thenext. It should be robust enough not to be injured during movement andshould maintain a deformable space between the vertebral body toaccommodate movement.

Disc protheses should last for the lifetime of the patient, should beable to be contained in the normal intervertebral disc space, shouldhave sufficient mechanical properties for normal body function, shouldbe able to be fixed to the vertebrae adjacent to the disc, should bepossible to implant, should not cause any damage should the disc fail,and should be biocompatible.

There are at least 56 artificial disc designs which have been patentedor identified as being investigated, McMillin C. R. and Steffee A. D.,20th Annual Meeting of the Society for Biomaterials (abstract) (1994),although not all these devices have actually been made or tested. Theycan be divided into two main categories. Lee et al., Spine, Vol. 16,253-255(1991). A first class includes devices for nucleus pulposusreplacements which includes metal ball bearing, a silicone rubbernucleus, and a silicone fluid filled plastic tube. Devices for total orsubtotal replacement of the disc have also been proposed such as aspring system, low-friction sliding surfaces, a fluid filled chamber,elastic disc prosthesis and elastic disc encased in a rigid column.

An example of total disc replacement is described by Urbaniak et al.,Bio. J. Med. Mater. Res. Sym., Vol. 4, 165-186 (1973) who developed andtested, using chimpanzees, an intervertebral disc device made of acentral silicone layer sandwiched between two layers of Dacron embeddedin the silicone. The open-mesh Dacron was chosen to allow tissueingrowth for fixation to the adjacent vertebrae. While spinal mobilitywas restored and the device tolerated by the host, due to inexact fit ofthe device, bone resorption and reactive bone formation were observable.Loose fibrous tissue also indicated possible movement of the device.

Hou et al., Chinese Medical Journal, Vol. 104(5), 381-386 (1991),developed a disc implant made of silicone rubber which restored normaldisc function. However, the presence of fibrous tissue surrounding theimplant indicated possible movement of the device.

The SB Charite intervertebral disc endoprosthesis, White and Panjabi,Clinical biomechanics of the lumbar spine, Churchill Livingstone, London(1989), which has been tested clinically, is fabricated from a biconvexpolyethylene core sandwiched between two concave-molded titaniumend-plates. However, the endoprosthesis shows insufficient mechanicalperformance and unlikely long-term bone fixation to the device.

Two types of disc prostheses were developed and evaluated by Lee et al.,35th Annual Meeting of the Orthopaedic Research Society, Las Vegas,Nev., Feb. 6-9 (1989); Dacron fiber-reinforced polyurethane elastomer(reinforcement located for the annulus section), and a prosthesis madefrom thermoplastic polymer which is increasingly rigid moving from thenucleus out to the end-plates. Yet another design is made ofcobalt-chromium-molybdenum (Co—Cr—Mo) alloy by Hedman et al., Spine,Vol. 16, 256-60 (1991).

U.S. Pat. No. 4,911,718 (Lee et al.), U.S. Pat. No. 5,002,576 (Fuhrmannet al.), U.S. Pat. No. 4,911,718 (Lee et al.) and U.S. Pat. No.5,458,642 (Beer et al.) also teach permanent intervertebral discendoprostheses for total disc replacement.

All of foregoing intervertebral disc prostheses, however, merely replaceall or a part of the disc with synthetic materials which must remain inplace ad infinitum. These prostheses are generally permanent implantswhich require observation of long term biologic responses throughout thelife of the prothesis. Furthermore, discs that are not comprised ofbiocompatible material may be rejected by the patient.

Procedures by which the tissues of the intervertebral disc are made toreform or replace the degenerated tissue of the intervertebral disc,would be highly desirable and a significant improvement over the currentstate of the art which presently use such permanent implants. Althoughefforts at tissue-engineering have been reported, no one has, until now,accomplished reformation of intervertebral disc tissue.

Repair of skin tissue has been achieved. For instance, skin deficiencieswhich arise in severely burnt patients or in decubitus wounds ofdiabetic patients have been so treated. Sabolinski, Biomaterials, Vol.17, 311-320 (1996). Cells are seeded onto templates of either resorbableor non-resorbable material. Once tissue begins to form the templates aredressed onto the site in need of treatment. Tissue engineering of theskin, however, is significantly different from tissue engineering of theintervertebral disc because tissue compositions differ significantly. Inaddition, the mechanical requirements of engineered skin tissue aresignificantly different from those of intervertebral disc tissue.

Some intervertebral disc prostheses provide for regrowth of theintervertebral disc and concurrent resorption of the prothesis. Forexample, U.S. Pat. Nos. 4,772,287 and 4,904,260 (Ray et al.) teachprosthetic discs having an outer layer of strong, inert fibersintermingled with bioresorbable materials which attract tissue ingrowth.However, this prosthesis is purely a synthetic material at the time ofimplantation and does not include any cells or developing tissue. Inaddition, it provides only partial resorption and the problemsassociated with permanent implants remain.

U.S. Pat. Nos. 5,108,438 and 5,258,043 (Stone) teach a porous matrix ofbiocompatible and bioresorbable fibers which may be interspersed withglycosaminoglycan molecules. The matrix serves as a scaffold forregenerating disc tissue and replaces both the annulus fibrosus andnucleus pulposus. However, replacement of this much tissue is arelatively invasive procedure which requires lengthy recovery time.Furthermore, these matrices do not use any cells to stimulate tissuerecovery nor is there any incipient tissue formation in this device atthe time of implantation.

Various materials have been seeded with cells in order to facilitatecell function including proliferation and extracellular matrixsynthesis. For instance, El-Ghannam, et al., Journal of BiomedicalMaterials Research, Vol. 29, 359-370 (1974), teaches in vitro synthesisof bone-like tissue using bioactive glass templates. Schepers, et al.,J. Oral Rehab., Vol. 18, 439-452 (1991), analyzed the use of bioactiveglass as fillers for bone lesions. Also, porous polymeric matrices havebeen used. The polymers include poly(lactic acid), poly(glycolic acid)and their co-polymers. However, these polymers have not been taught tobe appropriate substrates for intervertebral disc cells which until nowhave not been used to seed implants of any sort.

Ideally, intervertebral disc treatment would guide and possiblystimulate the reformation of the tissue of affected intervertebral disc,especially nucleus pulposus and annulus fibrosus tissue. It could alsobiodegrade while allowing concurrent nucleus pulposus and annulusfibrosus tissue ingrowth, thereby providing for disc regeneration. Suchan intervertebral disc material which is biodegradable while stillsatisfying the mechanical requirements of an intervertebral disc, hasnot been available until now.

OBJECTS OF THE INVENTION

An object of the present invention is to provide a method of inducingand/or guiding intervertebral disc reformation using biodegradablesupport substrates.

In yet another object of the present invention is provided biodegradablesubstrates useful for intervertebral disc tissue reformation.

Still another object of the invention is to provide material useful forguiding and/or stimulating intervertebral disc tissue reformation.

Another object of the invention is to provide methods of culturingintervertebral disc cells.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an exemplary hybrid material of thepresent invention.

SUMMARY OF THE INVENTION

In accordance with methods of the present invention there are providedmethods for repairing damaged or degenerated intervertebral discs. Thesemethods comprise evacuating tissue from the nucleus pulposus portion ofa degenerated intervertebral disc space, preparing hybrid material bycombining isolated intervertebral disc cells with a biodegradablesubstrate, and implanting the hybrid material in the evacuated nucleuspulposus space. In accordance with methods of the inventionintervertebral disc cell growth is guided and/or stimulated andintervertebral disc tissue is reformed.

Methods of culturing intervertebral disc cells are also provided in someaspects of the invention whereby intervertebral disc tissue is digestedwith collagenase and incubated in medium supplemented withhyaluronidase.

In still other aspects of the invention biodegradable substrates areprovided comprising polymer foam coated with bioactive materials, whichsubstrates are useful for intervertebral disc tissue reformation.

In yet another aspect of the invention are provided hybrid materials forreforming degenerate intervertebral disc tissue. The hybrid materialscan be made in the form of shaped bodies comprising biodegradablesubstrate and intervertebral disc-cells.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is directed to methods of inducing intervertebraldisc repair by reformation of intervertebral disc tissue. By implantinga hybrid material comprising intervertebral disc cells and abiodegradable support substrate into the intervertebral disc space,ingrowth of intervertebral disc cells is induced. Thus, the presentinvention provides methods of inducing self-regeneration of viabletissue and functional joints.

Methods of the present invention are useful to treat vertebratessuffering from degenerated intervertebral disc conditions, and inparticular may be used to treat humans with such conditions.

A degenerated intervertebral disc has lost or damaged some or all of itsintervertebral disc tissue, primarily including its nucleus pulposustissue, due to any number of factors discussed herein, including age andstress due to rotational loading. Degenerated discs vary in severityfrom bulging discs to herniated or ruptured discs. Patients sufferingfrom a degenerated disc experience a number of symptoms which includepain of the lower back, buttocks and legs and may also include sciaticaand degenerative spondylolysis. In accordance with methods of thepresent invention reformation or regeneration of intervertebral disctissue occurs in situ, replacing lost or damaged tissue and resulting inamelioration or elimination of the conditions associated with thedegenerated disc.

In accordance with the present invention hybrid materials used to induceand/or guide reformation of intervertebral disc tissue comprisebiodegradable substrates. Biodegradable means that the substratedegrades into natural, biocompatible byproducts over time until thesubstrate is substantially eliminated from the implantation site and,ultimately, the body. Preferably in accordance with methods of thepresent invention, the rate of biodegradation of the substrate is lessthan or equal to the rate of intervertebral disc tissue formation suchthat the rate of tissue formation is sufficient to replace the supportmaterial which has biodegraded.

In some aspects of the present invention the biodegradable substrate maybe bioactive. Bioactive, as used herein, is meant to refer to substrateswhich enhance cell function as compared to cell function of the samecell type in the absence of the substrate. For instance, bioactive glassgranules have been shown to enhance cell growth of typical bone cells.Schepers et al., U.S. Pat. No. 5,204,106. In addition, dense bioactiveglass discs have been found to enhance osteoprogenitor celldifferentiation beyond even those levels of enhanced differentiationelicited by bone morphogenic protein. H. Baldick, et al., Transactions5th World Biomaterials Conference, Toronto, II-114 (June, 1996).

The biodegradable substrate must also have sufficient mechanicalstrength to act as a load bearing spacer until intervertebral disctissue is regenerated. In addition, the biodegradable substrate must bebiocompatible such that it does not elicit an autoimmune or inflammatoryresponse which might result in rejection of the implanted hybridmaterial.

Biodegradable support substrates useful in methods of the presentinvention include bioactive glass, polymer foam, and polymer foam coatedwith sol gel bioactive material.

In accordance with some methods of the present invention bioactive glassis employed as a substrate. Bioactive glass is described in U.S. Pat.No. 5,204,104, incorporated by reference herein in its entirety. Thebioactive glass contains oxides of silicon, sodium, calcium andphosphorous in the following percentages by weight: about 40 to about58% SiO₂, about 10 to about 30% Na₂O, about 10 to about 30% CaO, and 0to about 10% P₂O₅. In preferred embodiments of the invention the nominalcomposition of bioactive glass by weight is 45% SiO₂, 24.5% Na₂O, 24.5%CaO and 6% P₂O₅ and is known as 45S5 bioactive glass. Bioactive glassmay be obtained from commercial sources such as Orthovita, Inc.(Malvern, Pa.).

Granule size of the bioactive glass is selected based upon the degree ofvascularity of the affected tissue and generally will be less than about1000 μm in diameter. In some embodiments of the present invention it ispreferred that the bioactive glass granules be from about 200 μm toabout 300 μm in diameter. In still other embodiments of the presentinvention granule size is from about 50 μm to about 100 μm.

In some embodiments of the present invention bioactive glass has pores.Percent density (100%—percent porosity) of less than about 80% may beused in some aspects of the invention. Percent density of about 10% toabout 68% can be used for other aspects of the invention. In someaspects of the present invention the pore size should be less than about850 μm in diameter while about 150 μm to about 600 μm pore diameter ispreferred.

One method of preparing porous bioactive glass is by mixing bioactiveglass granules of a desired size with sieved sacrificial agent camphorparticles of a desired amount and size. The camphor sublimates duringsintering leaving pores in the sintered glass. Thus, the averageparticle size and weight percent of the camphor particles is chosen tooptimize the pore size and percent porosity, respectively, of the glass.In some aspects of the invention particle size may be less than about850 μm in diameter while about 150 μm to about 600 μm is preferred.Thereafter the glass may be treated with any aqueous buffer solutioncontaining ions, the identity and concentration of which is found ininterstitial fluid. Said treatments result in the formation of a calciumphosphate rich layer at the glass surface. Typical buffers include thoseprepared as described by Healy and Ducheyne, Biomaterials, Vol. 13,553-561 (1992), the subject matter of which is incorporated herein byreference in its entirety.

In still other aspects of the present invention the support substratecomprises polymer foam. Polymer foam useful in these aspects of theinvention are biocompatible and include polyglycolide (PGA),poly(D,L-lactide) (D,L-PLA), poly(L-lactide) (L-PLA),poly(D,L-lactide-co-glycolide), (D,L-PLGA),poly(L-lactide-co-glycolide)(L-PLGA), polycaprolatone(PCL),polydioxanone, polyesteramides, copolyoxalates, and polycarbonates.D,L-PLGA, which is preferred in some embodiments of the invention, maycomprise 50% polylactide and 50% polyglycolide. About 75% polylactideand about 25% polyglycolide is still more preferred although it isanticipated that ratios may be varied to optimize particular features ofthe individual polymers. For instance, the mechanical strength of apolymer may be adjusted by varying the percentage of PLA and thepercentage of PGA may be adjusted to optimize cell growth.

In some aspects of the invention polymer foam is coated with sol gelbioactive material. Sol gel materials include glasses and ceramics. Suchbioactive compound are prepared by mixing a desired polymer foam withNaCl to create the desired porosity and pore size. Thereafter, thepolymer, including the pores and interstices, is coated with sol gelmaterial.

Sol gel glass is prepared by combining a metal alkoxide precursor withwater and an acid catalyst to produce a gel. A typical process isdescribed in U.S. Ser. No. 08/477,585 (U.S. Pat. No. 5,591,453) which isincorporated by reference herein in its entirety. Once dried the gelconsists mostly of metal oxide with a glass consistency. Sol gelbioactive material may be comprised of from about 60 to about 100%silicon dioxide, up to about 40% calcium oxide and up to about 10%diphosphorous pentoxide. A final product of 70% SiO₂, 25% CaO and 5%P₂O₅ is preferred in some methods of the present invention although theconcentration of each may be adjusted to optimize critical features ofthe sol gel. Other sol gel materials may be prepared by methods known inthe art. For instance, Qui, Q., et al., Cells and Materials, Vol. 3,351-60 (1993), incorporated by reference herein in its entirety, teachesmethods of preparing calcium phosphate sol gel bioactive material.

To coat the polymer, the polymer foam is dipped into the sol during thesol gelation phase. The sol-filled foam is then placed in a syringefilter and the sol is pulled through the foam by creating a vacuum belowusing the syringe. Thus, the polymer is substantially coated with solgel, with residual sol gel being evacuated from the polymer matrices.While it is preferred that most or all of the polymer surfaces,including the surfaces of the pores and interstices, be coated with solgel bioactive glass, polymers which are only partially coated with solgel bioactive glass may also be useful in some aspects of the presentinvention. It is desired in some embodiments of the invention thatgreater than about 50% of the polymer surface be coated.

To prepare the hybrid material, intervertebral disc cells are combinedwith biodegradable substrate material. Intervertebral disc cells may beisolated from tissue extracted from any accessible intervertebral discof the spine. For instance, tissue may be extracted from the nucleuspulposus of lumbar discs, sacral discs or cervical discs. Preferably,intervertebral disc cells are primarily nucleus pulposus cells. In someembodiments it is preferred that disc cells are at least 50% nucleuspulposus cells while 90% nucleus pulposus cells is still more preferred.Cells may be obtained from the patient being treated, or alternativelycells may be extracted from donor tissue.

The present invention provides advantages over prior art methods in thatthe entire degenerated disc need not be removed to treat a degenerateddisc. Rather, only the nucleus pulposus tissue need be evacuated fromthe degenerated intervertebral disc. Degenerated nucleus pulposus refersto a region of the intervertebral disc where the tissue has severelyreduced mechanical properties or which has lost some or most of thenucleus pulposus tissue. The present invention thus provides a lessinvasive procedure than that of the prior art. In addition, the methodsand hybrid materials of the present invention prompt biological repairof normal tissue in the disc which will result in better long termresults than that obtained with synthetic prostheses.

Evacuation of the degenerated intervertebral disc tissue, and primarilythe nucleus pulposus tissue, is performed using known surgical toolswith procedures developed to meet the needs of the present invention.Generally an incision or bore is made at the lateral edge in the annulusfibrosus and the intervertebral disc tissue is extracted from thenucleus pulposus via, for example, the guillotine cutting approach. Thetissue may be extracted using a scalpel, bore, or curette.Alternatively, tissue may be aspirated. Ideally, the annulus fibrosus,or significant portions thereof, are left intact. It is preferred forinstance, that at least 50% of the annulus fibrosus remain intact. It isstill more preferred that at least 85% of the annulus fibrosis remainintact. Arthroscopic techniques are most preferred in accordance withmethods of the present invention.

Similar surgical techniques are utilized to extract intervertebral disctissue from other, non-degenerate intervertebral discs of the spine ofthe patient or donor. For instance, similar techniques may be used toobtain intervertebral tissue from sacral discs. Minor modificationsnecessary to tailor the procedure to a particular region of the spinewould be appreciated by those skilled in the art.

Where there is lag time between tissue evacuation and implantation ofthe hybrid material, the evacuated space may be temporarily filled withgel foam or other load bearing spacers known in the art.

Intervertebral disc cells are isolated from extracted tissue. Generally,tissue is fragmented and treated with enzymes such as collagenase todisaggregate the cells into individual cells. Preferably isolated cellsare primarily nucleus pulposus cells with 50% nucleus pulposus cellsbeing preferred and 90% nucleus pulposus cells being more preferred. Thecells are isolated using centrifugation. Cells may then be combined witha biodegradable substrate and implanted into the evacuated nucleuspulposus. Alternatively, isolated intervertebral disc cells may becultured alone or seeded onto a biodegradable substrate and culturedtogether with the biodegradable substrate for later implantation.

In some aspects of the present invention the hybrid material may alsoinclude factors to enhance cell growth. For instance, TGF-β and EGF maybe added to the hybrid material to enhance cell growth. Cells may beincubated alone or seeded on a substrate in a tissue culture medium suchas Dulbecco's Modified Eagle Medium (DMEM) (pH 7.0), which may besupplemented with serum such as heat-inactivate fetal bovine serum.Antifungal and antibacterial agents may also be added. In preferredmethods of the present invention cells are incubated with about 0.5% toabout 1.5% hyaluronidase.

In some aspects of the present invention the end plate may be partiallydecorticated to enhance vascularization. Thereafter, cells may beimplanted or alternatively, after cell attachment, hyaluronidase isremoved and incubation is resumed with a medium supplemented with 0.001%ascorbic acid in the absence of hyaluronidase. Medium supplemented with0.0025% ascorbic acid is used to replenish the cell solutions.

Hybrids of intervertebral disc cells and biodegradable substrate maythen be implanted into the evacuated intervertebral disc space usingsurgical procedure such as described above.

Hybrid materials are provided by the present invention. Such hybrids canthen be shaped for insertion into the intervertebral disc space of apatient. Exemplary FIG. 1 shows a shaped hybrid material comprisingbiodegradable substrate and intervertebral cells. Intervertebral cellsare located on the outer surface 10 and on the surfaces of the pores andinterstices 12 of the shaped substrate. It should be noted that FIG. 1depicts one possible embodiment and should not be construed as limitingthe invention in any way.

The substrate should generally have a rectangular shape. A cylindricalpad shape is also envisioned.

The following examples are illustrative but are not meant to be limitingof the present invention.

EXAMPLES Example 1 Evacuation of Nucleus Pulposus

Mature New Zealand rabbits weighing 4-5 kg are used. For each rabbit,L4-L5 or, when possible L4-L5 and L5-L6 disc spaces are accessed asthose are the biggest sections. The anesthetics Ketamine, HCl 30 mg/kg,and Xylazine 6 mg/kg, are administered intramuscularly. Using aparaspinal posterolateral splitting approach, the large cephalad-facingtransverse process of the lumbar spine is identified and removed with arongeur. The intervertebral disc can then be seen. An incision is madein the annulus fibrosus. Using a high-power surgical microscope, thenucleus pulposus tissue is scraped out carefully with a curette. Thespace is then packed with gel foam. The rabbit is closed provisionally.

Example 2 Isolation of Intervertebral Disc Cells

Intervertebral disc tissue is obtained as described in Example 1 or froman amputated tail section. Under aseptic condition, the intervertebraldisc tissue is diced with a scalpel and placed in a T25 tissue cultureflask with Dulbecco's Modified Eagle Medium (DMEM) adjusted to pH 7.0,supplemented with 10% heat inactivated fetal bovine serum and 1%penicillin/streptomycin (TCM). The tissue is then treated with 0.25%collagenase for two hours at 37 ° C. An equal amount of TCM tocollagenase is added to stop treatment. The mixture is centrifuged at1000 r/min for 10 minutes and supernatant is discarded. TCM is added andthe mixture is filtered to remove debris. The mixture is againcentrifuged and supernatant discarded. Cells are resuspended in TCMsupplemented with 1% hyaluronidase (400 u/ml).

Example 3 Culture of Intervertebral Disc Cells

Cells are cultured in TCM supplemented with 1% hyaluronidase (400 u/ml)at 37° C. in 5% CO2/95% air. Once cells attach medium is changed to TCMsupplemented with 0.001% ascorbic acid in the absence of hyaluronidase.Cells are resuspended in fresh medium supplemented with 0.0025% ascorbicacid every 3 days.

Example 4 Preparation of Bioactive Glass

Bioactive glass granules (45S5) having diameters of 40 μm to 71 μm canbe obtained from Orthovita, Inc. (Malvern, Pa.). Prior to implantationor addition to cell culture, the specimens are sterilized in ethyleneoxide.

Example 5 Preparation of Sintered Porous Bioactive Glass

Bioactive glass granules having diameters of 40 μm to 71 μm can beobtained from Orthovita, Inc. (Malvern, Pa.). The glass granules aremixed with 20.2 weight % sieved sacrificial agent camphor C₁₀H₁₆O withgrain size of 300 μm to 500 μm. The mixture is mechanically mixedovernight, and cold pressed at 350 MPa. The disc obtained is heattreated at 575° C. for 45 minutes. The heating rate is 10° C./min. It isthen left to cool at room temperature. The disc is immersed in acetonefor 30 minutes and dried at 37° C. The disc is cut to the desireddimensions using a diamond-wheel saw. The disc is washed in acetone for15 minutes. The specimen is then conditioned in tris buffer withelectrolytes added (TE) (El-Ghannam, et al., Journal of BiomedicalMaterials Research, Vol. 29, 359-370 (1974)), for 2 days to obtain thedesired formation of calcium phosphate-rich layer at the glass surface.The specimen is rinsed with methanol and dried at 37° C. The specimen isanalyzed using scanning electron microscopy (SEM), Fourier TransformInfrared (FTIR) spectroscopy and X-ray diffraction (XRD). Prior toimplantation or introduction to cell culture, the specimen is sterilizedin ethylene oxide.

Example 6 Preparation of Polymer Foam

3 g of NaCl with particle sizes 300 μm to 500 μm, and 2 g of D,L-PLGA75/25 (75% polylactide/25% polyglycolide) polymer foam were mixed. Thedispersion is vortexed and cast in a 5 cm petri dish. The solvent isallowed to evaporate from the covered petri dish for 48 hrs. To removeresidual amounts of chloroform, the petri dish is vacuum-dried at 13 Pafor 24 hrs. The material is then immersed in 250 ml distilled deionizedwater at 37° C. for 96 hrs. The water is changed every 12 hrs to leachout the salt. The salt-free membrane is air-dried for 24 hrs, followedby vacuum-drying at 13 Pa for 48 hrs. The material is then cut to thedesired geometry with a razor blade. The membrane is stored in adesiccator under vacuum. The specimens are analyzed using SEM. Thespecimen will have 60% pore density with pore sizes 300 to 500 μm. Priorto implantation or introduction into cell culture, the specimens aresterilized in ethylene oxide.

Example 7 Preparation of Polymer Foam coated with Sol Gel BioactiveGlass

Tetramethylorthosilane(TMOS),calcium methoxyethoxide and triethylphosphate are mixed for 5 minutes in an argon atmosphere using amagnetic stirrer. Respective amounts of each are chosen such that theresulting product is 70% SiO₂-25%CaO-5%P₂O₂ (upon drying). They aremixed using a magnetic stirrer for 5 min. The PLGA polymer foam preparedaccording to Example 5 is dipped into the sol approximately halfway togelation. The foam is dipped 2 to 3 times to make sure that the solcompletely fills the polymer foam. The sol-filled foam is then placed ina syringe filter with appropriate filter pore size which only allows thesol to flow through. This syringe filter is attached to a syringe. Thesol is pulled through the foam by creating a vacuum below using thesyringe. EDAX and SEM are used to analyze pore size, porosity and thethickness/uniformity of the sol gel bioactive glass coating. Prior toimplantation or introduction to cell culture, the specimens aresterilized in ethylene oxide.

Example 8 Cell Phenotype

Cell phenotype of cells cultured in accordance with the method ofExample 3 is examined. Immunofluorescent staining of cells showspositive staining for proteoglycan and collagen type II, markers ofintervertebral disc cell phenotype. Substantially negative staining forcollagen I, a annulus fibrosus marker, was also observed.

Example 9 Cell Reversion

Intervertebral disc cells cultured as described in Example 3 are testedfor reversion. Cells are placed in Eppendorf tube with TCM and spun downto form a pellet. Cell histology is examined after 4, 8 and 12 days bywashing the pellet and fixing it with 70% ethanol. The cells aredehydrated, embedded and cut. The sample is stained withhematoxylin-eosin and toluidine blue.

The histology of cultured cells is compared to the histology of nucleuspulposus tissue prepared immediately upon retrieval. Histology of thecells evidences a reversion to the original morphology of the cells.

Example 10 Implantation of Biodegradable Substrate

Cells are prepared in accordance with Examples 2 and 3. Cells arecounted. Biodegradable substrates prepared as described in Examples 4-7each placed in a tissue culture dish and immersed in TCM for 1 hour. Thecells are seeded onto each of the sterile biodegradable substratesprepared as described in Examples 4-7 in TCM with hyaluronidase and leftto attach for at least one hour before flooding the dish with TCM. Cellsare incubated overnight. Attachment is detected using SEM.

The rabbit treated as described in Example 1 is reopened per surgicaltechnique described in Example 1, and the intervertebral disc spaceaccessed. The gel foam is retrieved and the cell-biodegradable substratehybrid material inserted in place. The wound is closed.

Example 11 Effect on Neurological Function

Regular post-operative neurological functions are evaluated to examinethe subject for any spinal injury such as lameness. The effect of thehybrid material on the behavior of the disc can be observed andgenerally compared by taking radiographs of the spine immediatelypre-operation, post-operation and at 1 month time periods until theanimal is sacrificed.

Example 12 Histological Analysis

Histological analysis is performed to determine cell ingrowth, celltypes, tissue morphology, and absence of inflammation. To this end, theretrieved disc is fixed in 70% ethanol and dehydrated. After embeddingin methyl methacrylate, sections are cut with a diamond saw, ground,polished with silicon carbide paper and diamond paste, and stained.Histology is done on normal discs and discs retrieved at the varioustime periods. Analysis will show ingrowth of cells with concurrentdegradation of implanted hybrid material with little to no inflammation.

What is claimed is:
 1. A method of reforming degenerated nucleuspulposus tissue of an intervertebral disc of a patient comprising thesteps of: A.) evacuating the degenerated nucleus pulposus tissue fromthe intervertebral disc of said patient to form an evacuated nucleuspulposus space; B.) preparing a hybrid material by combiningintervertebral disc cells with a biodegradable substrate; andC.)implanting the hybrid material in the evacuated nucleus pulposusspace of step A.
 2. The method of claim 1 wherein the biodegradablesubstrate is bioactive.
 3. The method of claim 1 wherein thebiodegradable substrate is bioactive glass, polymer foam, or polymerfoam coated with sol gel bioactive material.
 4. The method of claim 3wherein the polymer foam is the copolymer D,Lpoly(lactide-co-glycolide).
 5. The method of claim 4 wherein thecopolymer comprises 75% polylactide and 25% glycolide.
 6. The method ofclaim 1 further comprising isolating cells for step B of claim 1 from anintervertebral disc.
 7. The method of claim 6 wherein cells are isolatedfrom the nucleus pulposus of an intervertebral disc.
 8. The method ofclaim 6 further comprising culturing intervertebral cells on thebiodegradable substrate prior to implantation.
 9. The method of claim 6further comprising culturing intervertebral cells prior to combiningcells with the biodegradable substrate.
 10. The method of claim 9wherein intervertebral cells are combined with the biodegradablesubstrate to form a hybrid material immediately prior to implanting thehybrid in the evacuated nucleus pulposus space.
 11. The method of claim1 wherein the substrate is bioactive glass granules of less than 1000 μmin diameter.
 12. The method of claim 1 wherein the substrate is porous.13. The method of claim 12 wherein the substrate contains pores withdiameter of less than about 850 μm.
 14. The method of claim 12 whereinthe substrate has a percent density of less than about 80%.